Medicare Prescription Drug Benefit (Medicare Part D) FAQ : Human Services : Arlington, Virginia

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Medicare Prescription Drug Benefit (Medicare Part D) FAQ

Medicare Prescription Drug Coverage (Medicare Part D) Began January 1, 2006

• Who is eligible?: Individuals who are enrolled in Medicare Part A or enrolled in Medicare Part B, regardless of income.
• If you are eligible for Medicare Part D,: You must make some important decisions about your prescription drug coverage and you may need answers to at least some of these questions:
• Am I eligible for financial assistance?: If your current annual income is below $16,245 (individual) or $21,855 (couple) and you have limited assets, the answer is “yes.”
• If eligible for financial assistance, how do I apply?: At your Agency on Aging, a local Social Security office, local department of Social Services, or online at www.socialsecurity.gov .
• What if I receive Medicaid?: Dual eligibles (Full Medicare and Full Medicaid) will be enrolled in a Plan with the full subsidy. Partial eligibles (QMB, SLMB, QI-1) will be deemed eligible for one of the levels of a subsidy and will also be enrolled in a plan.
• What if I have retiree health insurance?: The company will notify each beneficiary at least by November 15, whether or not the policy’s drug benefit is “creditable,” as good as or better than the Medicare Prescription Drug Benefit for the upcoming year.
• What if I have Tricare, VA benefits, or a Medigap policy?: Tricare For Life has a creditable benefit. VA is creditable. Federal Government plans are creditable. Old Medigap plans with prescription drug coverage are not creditable.
• What if I am new to Medicare?: You have an initial enrollment period from the time you are entitled to Part A or enrolled in Part B. You have the same 7-month period that begins 3 months prior, the month of, and through the 3 months after you are eligible.
• What if I am in a Medicare HMO?: The Medicare HMO will have to inform their members as to whether or not the drug benefit that is part of the HMO is creditable.
• How much will Part D cost?: For people who do not qualify for a subsidy, there is a deductible ($295), a monthly premium and cost sharing (25%) of medication cost until the total retail cost paid by you and Medicare together reaches $2,700. At that point, you pay 100% of the drug costs until your total out-of-pocket costs reach $4,350.
• When does enrollment begin?: Every year, open enrollment begins November 15 and lasts through December 31.
• How will I enroll in a Part D plan?: Dual eligibles will be auto-enrolled. Partial eligibles will have facilitated enrollment, but are encouraged to choose their own plan. All others should choose their own plan when they become eligible.
• Will the drugs I need be covered under Part D?: Each plan will have a formulary of prescription drugs covered. Special exceptions will be made in some circumstances.
• How will I find out what plans are being offered and what drugs are covered under each plan?: Plans will be announced beginning October 15 each year.
• What happens if I do nothing?: If you do not have other “creditable” drug coverage and you decide not to enroll in a Part D Plan, you might be charged a penalty of 1% of the premium amount for every month you were not enrolled from the time you first became eligible.